=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578973558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALM WATERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2014
-----------------------------------------------------
Last Update Date | 04/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1840 MAYVIEW ROAD SUITE 204
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-200-0791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2439 HUNTINGTON DRIVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | STACIE L SEBASTIAN
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 412-200-0791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PC007527
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------